August 25, 2009

Final Reflections

by Glenn Quarles

As much as I hate to say it, my time in South Africa has now come and gone. Calandra Miller and I safely arrived back on American soil at 7:30 AM on August 6, 2009. At the time, I could not say the same for our luggage, which remained (safely) in Johannesburg, South Africa.

The last couple of weeks spent in South Africa were bittersweet, to say the least. I was looking forward to coming home and seeing my family and friends once again, but at the same time I was having to say goodbye to many good friends and, what I consider to be, family back in South Africa. The volunteer girls, Betty, Eva, and Engelinah treated us to some milkshakes as a going away present. This was a distinct honor to me, because what we might take for granted in the United States, they had to budget for weeks in advance. We also spent some time celebrating with Stefan and his family, the Wiids (the family who hosted me in their cottage during my stay in SA), and Pastor Dave Garton and his wife Gail (who run the rehab program that Project HOPE is partnering with). In the midst of our imminent departure, I took some time to reflect on what I was doing and had done since arriving in South Africa.

My purpose for being in South Africa was to assist in the fledgling steps of a promising program targeted towards orphans and other vulnerable children. Calandra and I had the distinct privilege to contribute our work to laying the foundation on which this program could get started. Much of this consisted of doing what many would consider mundane: data collection. Day in and day out we went door to door asking the same questions for our rapid needs assessment. After all was said and done, we had a grand total of 185 caregiver surveys and 266 parenting maps for children. This data has since been used by Project HOPE for grant proposal writing and other fund raising endeavors. All of our labors brings to mind a famous quote from Dr. Irving J. Selikoff, "Statistics are human beings with the tears wiped away." I can now whole-heartedly attest first hand to this, and with nearly every interview was reminded of why I was there.

My translator and I entered into a dimly lit home constructed entirely of sheet metal where we found a frail middle-aged woman crouched down washing the red clay dust off some furniture in her small room. She was obviously ill, and barely had the strength to stand and greet us with the customary handshake. Yet, when asked to take part in our survey she eagerly agreed and carefully sat down on the edge of her bed. Throughout the entire interview the woman provided responses through restrained whimpers and sobs. The questions I asked were simple, non-intrusive, and were not targeted toward specific health conditions. I could only assume it was due to her being overwhelmed with her health and living conditions. At the conclusion of our interview, she pleaded for any help we could give her, but all I could do was offer her a hug and a promise of my prayers, which she gratefully accepted. For many, the only hope they have is their faith in God to deliver them from their squalid conditions.

While walking through the dusty, debris ridden streets of the Zenzele settlement with Betty as my translator, I saw three men sitting on buckets in front of their home singing a song. I didn't think much of it, and continued on to the next person's home to conduct another survey. About 20-30 minutes later, we emerged to these same three men singing the same song. I asked Betty what they were singing out of curiosity. "God have mercy on us," she said.

Unfortunately, many of these people will not find much refuge from the currently overwhelmed healthcare system in South Africa. Residents of these settlements have told us that healthcare providers will often mistreat or even completely overlook them when it is discovered that they are not native South Africans. This is only exacerbated by the physician strikes taking place all around the country due to poor salaries and working conditions.

This is not by any means encouraging for a woman who volunteered for a field test of the Munsieville Survey Calandra and I had designed for Project HOPE. She was 23 years old, and spoke English well enough for me to conduct most of the survey without Betty's help. Within this survey were much more detail oriented and intrusive questions, including those that asked about sexual behavior. After completing the field test, Betty and I struck up a conversation with this woman to discuss the strengths and weaknesses of the survey. When I least expected it, she volunteered to us some extremely sensitive information that she would only entrust to her closest friends and family. She had AIDS. On top of this, she also told us that she had recently been diagnosed with breast cancer in her left breast (which she reported only having pain medications for). Her live-in boyfriend and sole bread winner for the family (making about R800 per month, or around $100 U.S.) also had AIDS. While he was at work, she was responsible for raising their young 2 year old child in the small shack they called home. I was deeply honored by her telling this to us. It was as though she trusted us, as representatives of East Tennessee State University, Project HOPE, and Hope Through Healing Hands, like we were family. She understood that we were there to help and wanted to change the conditions that they lived in for the better.

Even though she was just one year younger than myself, I couldn't help but think about her as a child no more than 10 years ago. There was no one around to teach her safe sexual practices, or to help her get a proper South African identification card. There were no concerted efforts to give her the proper education she needed to become an empowered woman and begin the climb out of poverty's grasp. Then it struck me. This is why Calandra and I are here. This is the spirit of public health, to prevent terrible outcomes like this regardless of where they come from or what gender they are. Though her story was transformed into categorical and continuous variables in a database, her story, in conjunction with many others, will be used in research by Project HOPE and its partnering organizations to help prevent suffering like this for future generations.

I feel honored to have taken part in Project HOPE's endeavors in South Africa. Without Hope Through Healing Hands and the Frist Global Health Leaders Program, it would not have been possible for me to contribute to this great cause. Through this experience, I have gained tremendous into what it is like to operate a health campaign in a foreign country, something that I plan to pursue professionally when I am finished with my formal education. I am forever grateful for having this opportunity, and will carry what I have learned from this experience for the rest of my life.

August 24, 2009

 

Today, after meeting all day with health reformers in China, it is clear that partnerships with U.S. academic institutions are important to build capacity and institutional support here. 

 

At Peking University, Dr. Ke Yang, Executive Vice President of Peking University (PKU), enthusiastically described the great results of a Duke-Peking University two-week global health diploma program with the School of Public Health.

 

By email, my friend and global leader at Duke University’s Global Health Institute, Mike Merson, M.D. also told me of Duke's training program in cardiovascular disease at Peking University Health Sciences Center and their partnership in a new Center of Excellence in Cardiovascular Disease Research led by Yengfeng Wu, M.D., Ph.D. that is based at The Georges Institute in Sydney, Australia.

 

And at Vanderbilt University’s Institute for Global Health, global health leader Sten Vermund, M.D., Ph.D. tells me Vanderbilt has a twelve year partnership with two sides of the Ministry of Health for training, the Foreign Loan Office and National Center for AIDS.  They have strong research ties in Guangxi, Xinjiang, and Yunnan Provinces (one large ongoing study in the former two provinces). Also, they have a special partnership on rural health management training that Governor Bredesen and Commissioner Matt Kisber have co-initiated and sponsored.  In fact, there are other VU links to China (history, business, education, etc) including the partnerships between Fudan University and VU as "peer partner institutions."

 

Frist Visits Ditan Hospital, Peking University, and Tennessee-China Development Center

August 23, 2009

Frist visited the Beijing Ditan Hospital which was the center for dealing with the SARS virus in 2003. Today, it has been refurbished to hold 500 beds. It is now designated as the H1N1 Hospital for China.

Frist visits with nurses inside Beijing Ditan Hospital. They are demonstrating how their PDA is monitoring H1N1 patients. The Senator notes that it is one of the most electronically integrated hospitals he's ever visited.

Frist meets with Vice President of Peking University. Peking University has eight hospitals and health science schools. There, he discussed health care reforms underway and how American health care companies can assist in improving health care in China today.

Senator Frist, Tommy Frist, and Chuck Elcan visit Tennessee China Development Center.

 

 

 

 

 

 

 

 

Sunday, August 23, 2009

9 pm, Beijing

In 2003, representing the U.S. Senate I met with President Hu Jintao, CMC Chairman Jiang Zemin, Premier Wen Jiabao, and the Foreign Minister and Health Minister. One evening there was a majestic dinner in our delegation's honor, similar to our State dinners, hosted by the NPC Chairman Wu Bangguo (who I understand is coming to DC in a couple of weeks). It was the height of the SARS crisis and China had been shut down. I remember so vividly the discussion we had in the Ambassador's residence in Japan (the country visited just prior to our planed trip to China) when I gathered all the Senators around to make a final decision of whether to enter China at a time of some risk. We decided to go ... to demonstrate our support of the Chinese government in those difficult times as it did its best to fight the new, frightening and deadly SARS virus.

I am reminded of all this as I enter China today and read the China Daily headlines in the airport, "H1N1 will endanger more lives," with a subtitle "Up to 2 Billion may be infected; China will see rise in cases this winter." The article goes on in the first few paragraphs to say that the number of H1N1 cases will double every three or four days until they reach the peak transmission period.

The world is a small place. SARS tore out of China and invaded Canada. The affected economies grounded to a halt. Similarly HINI will be a worldwide pandemic. There are no borders to these cagey and fatal viruses. We are all in this together and our response must be mutually dependent. We are one. There is no separation of global health from domestic health when it comes to these emerging diseases.

August 22, 2009

Frist Update and Expectations: Written on the plane to Shanghai

Just getting used to the new Prius. I am taking a lot of heat from my family who see me more the Tahoe or Suburban type. It was tough trading my 1992 Suburban (my only car) because of the family memories that centered on that car. I had saved some money back in ‘92 by getting a two wheel drive (though I regretted it later when in DC I kept getting stuck in the snow - sometimes doesn't pay to be too cheap); it was the car the boys learned to drive in the narrow streets of Georgetown (side mirrors a little scratched). I resisted this clunker deal initially because I thought it wrong that the taxpayer was buying my new car for me, but after a few days I broke down on the moral argument of mileage, pollution, etc (and the gift of the average taxpayer!!). I always buy my cars from Lee Beaman; his dad and mine were best friends. Christi, who works with me, picked out a great Yukon for me. But I opted for the Prius - why? Because it gets 4 times the gas mileage and I want to reduce gas consumption since so much of the proceeds goes to those who feed terrorism. And it is cheap - we actually ended buying two Pri(i) - one for me and one for my brother Tommy - for the price equal to one Yukon. Still hate to see the Suburban go - and it sounds like they poison it to kill it. Ugh.

Last week Karyn and I were in Nantucket and we hosted an annual clambake for family and friends. Brother Tommy and Trisha come up each year and on Friday night he said that he was going to China in two weeks. "Bill, why don't you and Karyn join us? You know many of the Chinese leaders from your previous Senate trips there; if you were there we could explain what we are doing and what we could potentially do to the central government." You see Tommy and his son-in-law are constructing a hospital that is public-private (government is 70%) in a community about 2 hours south of Shanghai.

Karyn and I had a trip planed to Italy that was to begin on September 1; we hade never vacationed in Italy and it was time for me to take her there since most of our friends at our age that we see day to day have been there multiple times. Our summer vacations have been working and doing surgery in Bangladesh, Mozambique, Uganda, southern Sudan, Darfur, and the Congo. Doing surgery in the bush is a far cry from Florence and Venice and the Amalfi Coast (as I was reminded by Karyn); Italy is the destination this year (and no surgery). No skimping here, I called the famed travel agent Andrew Harper and said just put together the rip for us. Karyn deserves it.

So now 2 weeks before departing to Italy how was I going to get a visa for us to China and then organize a trip there? With a lot of help we did it, and this morning at 3:15am we got up to board Delta to Atlanta and then Atlanta to Shanghai to Beijing. At this point, we have no idea what the plan will be until we see the Minister of Health on Wednesday (today is Saturday in the US).

I am not a China expert, but I am fascinated by the country and when I am advising young people today I tell them to focus on China and figure out some way to go there and live for awhile. The demographics and economic direction are just too clear as we look forward over the next 30 years.

In terms of health, the central government has made a major commitment in funding health services throughout China. And though the "down-side" of central command we all know in America is lack of democratic decision making and transparency, the "up-side" is that once a decision is made there is not a fiddling around to fund and accomplish the result. So with that much boldness directed at solving health inequities and improving health services, coupled with huge investment, I knew I wanted to be in China and get the lay of the land.

We will build the next 8 days around health and healing, be open to opportunities to share our expertise, learn from their culture and approach, and then just see what happens in the future. We're in the information gathering stages ... we are not up to the "conceive it, believe it, do it" phases frequently quoted by my mentor the pioneering heart surgeon Dr. Norman Shumway.

Everyone has a bucket list and we tend to pay more attention to them the older we get. Tommy says Tibet is on his, so the group said let's go. Then we heard that the altitude is 14,000 with no acclimation; I get altitude sickness and he had a minor heart procedure two weeks ago so the doctors said wait 6 months. A relief to me because I know I would be sick. Karyn does well at high altitude (like when we hiked the Virunga Mountains on the order of Rwanda and Uganda looking for the mountain gorillas - at 12,500 feet we eventually found them but I was so hypoxic I don't remember anything we did. Karyn thrived. I should just keep my medical work with the gorillas focused on the National Zoo over in Washington, DC instead of trekking in Rwanda, which was last year's trip - I know ... that is why we are doing Tuscany and Florence!).

So now that Tibet is out, we will do a non-health side trip to Xi'an, China, the ancient walled city, once the capital of China, and often overlooked. It is now known for the unearthed Terracotta Army of Warriors and horses of Emperor Qin Shi Huang. Apparently at night the city becomes the City of Lights and an atmosphere that leans on fantasy. One article describes an 18 course dumpling banquet (at De Fa Chang). That is the extent of what I know about the area now, more to come once Karyn and I figure out to get there.

So what is the kernel behind this trip in the first place? It starts with my oldest brother
Tom Frist who founded and ran Hospital Corporation of America, the largest hospital company in the world, and his son-in-law Chuck Elcan who two years ago set out on building a hospital in partnership with the government in China. The location for the hospital (approvals and funding have been obtained) is the city of Cixi (1.8 million people in immediate area) which is in the Zhejiang Providence. Cixi is directly east of Hangzhou and is a little over 2 hours south of Shanghai (directly across the bay).

So that hospital will be built and staffed and locally run (manages using the systems that have been fine tuned by years of western hospital management expertise). If that works and works well, what would the next step be? Our trip and our meetings with the government will help answer that, so it will be fun sharing my observations with you as we go through all this over the next 8 days. What we do know is that the Chinese government is making an unprecedented and monumental commitment to its health sector; they could use, I would think, some western expertise. This is not a venture of HCA. Luckily the third partner Henry Zhou lives in China and will be our host once we hit the ground.

 

August 22, 2009

 

This morning, we awoke early to catch a 5:00am flight out of Nashville, through Atlanta to Shanghai, China. Karyn, youngest son Bryan (21), brother Tommy, his wife Trish, and his son-in-law Chuck Elcan and I are all traveling to China to explore the Chinese delivery of health care. During my time in the Senate, at the height of the SARS crisis, I led a Senate delegation to China. They were honored we would come during this period, exhibiting the United States’ trust in the Chinese government to handle this unknown crisis.

      Today, we have a 14 hour flight to Beijing. Once there, we look forward to meeting the new Ambassador to China, Jon Huntsman, Jr. as well as the Minister of Health. We will be in Beijing, Shanghai, and Hong Kong over the next week. And, I’ll be blogging daily with updates on events and health care in China today. Stay tuned…

 

Overcoming Obstacles to Keep Girls in School: Sustainable, Environmental, and Economic Practices

by Anita Henderlight

August 18, 2009

Shortly after NESEI opened our first girls' boarding secondary school in South Sudan, we observed that many of the girls skipped classes routinely each month. Why? Because they did not have necessary supplies for comfort or cleanliness during menstruation. Most were using leaves or old rags to absorb their flow.

We began to supply the students with "comfort kits" - disposable sanitary products imported from more industrialized countries. They met our primary goal - keeping our girls in school.

We soon realized that we would eventually spend more on comfort kits than tuition fees and that we were creating a disposal and environmental problem in a community that had no functioning way to deal with garbage. We needed a financially and culturally appropriate solution - one that would keep girls self-assured and in class.

Thus, the NESEI sanitary pad sewing project was born. A generous group of people from York, South Carolina, invested $250 in a treadle sewing machine and donated patterns, fabric, thread, and needles. Our students begin making their own sanitary pads.

The locally-made pads are absorbent, soft and inexpensive to make. And because they are reusable, they are environmentally and community friendly.

In the first two months of the sewing project, the students made 500 pads. School attendance and personal hygiene have improved. And now the girls are coming up with a plan for a small business packaging and selling surplus pads to girls and women in the surrounding villages.

NESEI hopes to build capacity so we can help the girls market pads to other NGOs working in South Sudan. The girls will use the extra income to purchase additional scholastic materials and other needed items.

The sanitary pad program is another NESEI example of empowerment at work - a small investment is giving our girls the opportunity to find practical solutions to real problems.

In September, NESEI will launch a new, updated website (www.nesei.org) with information about the sanitary pad project and other programs which are contributing to the improved health and welfare of our young Sudanese friends.

**NESEI is a proud partner of the HTHH Global Health Coalition.

 

 

Glenn Quarles, Global Health Scholar

Munsieville, South Africa

August 17, 2009

Loni and I have continued our work on the Munsieville Survey and rapid needs assessment data collection. We can now officially say that our Munsieville Survey is fine-tuned and ready for implementation. Each survey takes about 45 minutes to an hour. I mentioned in an earlier update that Project HOPE had planned to get 1000 surveys. Well, thanks to some mathematical wizardry on my and Loni's part, we discovered that we would only need about 400 surveys to get the same statistical power (something that SIGNIFICANTLY cut on costs for this project). So, with 10 hired surveyors it would take a little less than 2 weeks to complete data collection.

Unfortunately, due to government holidays and political unrest, we will not be able to implement the survey before leaving South Africa. However, we have drawn up a strategy for implementation to help things go more smoothly for our boss, Stefan, when he finds the time and resources to carry it out in the next month or so.

As Loni mentioned in an earlier update, we have been continuing Project HOPE's ongoing quest to find a suitable location for its Munsieville Model by conducting rapid needs assessments in the informal settlements of the Randfontein area. Most recently, we have been shack counting and surveying in Big Elandsvlei (this is in addition to Master, Jabulane, Elandsvlei Klein or "small", and Zenzele). They call it "Big" Elandsvlei because it has more land than the other Elandsvlei settlement, though this in itself is misleading. We counted a total of 210 homes there, whereas at Elandsvlei Klein there were 350 densely packed onto a smaller plot of land. Elandsvlei was a bit different from the other settlements in that it had no formal system of sanitation, not even latrines. Nearly everyone used a bush toilet (i.e., dug a hole in the woods). One of the women we surveyed informed us that rape is a big problem when using the bush toilet in that settlement, something I'd never even considered before.

Due to the aforementioned political issues, there have been many strikes occurring throughout the entire country of South Africa, including both municipality workers and even physicians. The municipality worker strike has had a grave impact on the people living in informal settlements who have to rely on the water tanks to survive. Already residents in Big Elandsvlei were reporting to us that they'd been without a water tank refill for the past three days. Besides a dwindling supply of drinking water, this has had other impacts on the residents, specifically the children. They have not been going to school because there was not enough water to bathe or wash clothes. The parents are consequently refusing to send their children to school because of it.

In spite of the municipality strikes and the resultant disruption in services, we haven't had any issues with our rapid needs assessments. Big Elandsvlei is the last settlement Loni and I were tasked with surveying. Naturally, being interns, we were given the sacred responsibility of doing data entry for all of the surveys we have collected. We are nearly finished with inputting data for the 185 caregivers and 266 children in the above 5 mentioned settlements. Once finished, we'll hopefully have a preliminary analysis completed for Project HOPE before leaving for the States.

 

Senator Frist said "I fast to send a message to fellow leaders, fasters and activists that we must definitively address the cause of the ongoing violence and persecution in Darfur. It is an affront to our compassion, our decency and our very humanity that the government of Sudan has put racism, political and financial interests ahead of its people. I want the refugees in Darfur to know they are not forgotten and that we will not give up until we see peace come to our Sudanese brothers, sisters and children."

From Tanzania: Update from Krista Ford

August 10, 2009

           I haven't had the chance to go on anymore exciting field visits yet, but I have become more familiar with how NGOs work. My supervisor has been out of the country for the last two weeks and consequently I've been given a lot more responsibility. For example, I lead this month's meeting of the Quality Improvement Task Force. The Q.I. Task Force meets monthly to discuss issues pertaining to the quality and guidelines of the care and support of orphans and other vulnerable children (OVC) in Tanzania. My supervisor is a co-chair on the task force and she usually hosts the meeting but I led the meeting in her absence.  The task force is in the process of developing national guidelines for quality improvement of OVC care as well as a household status tool to be used in assessing the household conditions of OVC. The discussion about the process of creating and revising the documents gave me insight into how national guidelines for development work are established and the relationship between governmental ministries and non-governmental organizations.

            I was also invited to the Implementing Partners Group meeting in my supervisor's absence. This monthly meeting is a chance for NGOs and CBOs operating in Tanzania to come together and share best practices and lessons learned. At the meeting we discussed everything from a recent trip to Egypt to share promising practices to progress made on incorporating children with disabilities into mainstream education. I had assumed, since most NGOs target specific issues and populations, that they work independently but the IPG meeting revealed the interconnectedness of Tanzania's NGO community. So many of the NGOs/CBOs rely on each other as partners in implementation that they seem more like a network than a group of independent organizations.

            My next field visit is currently scheduled for September. I will be heading to Iringa (one of Tanzania's colder regions) to visit beneficiaries and implementing partners. My co-workers have been warning me that I will need to purchase a heavy jacket! I'm enjoying getting to know my co-workers here in the office and partners at other organizations but I am looking forward to traveling to other parts of Tanzania and witnessing the impact of OVC programming in the field.

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